Abstract
Background: In 1998 the FDA approved the use of hydroxyurea (HU) for use in patients (pts) with SCA. The trial on which the approval was based demonstrated that adult pts that were on HU had fewer hospitalizations, fewer episodes of acute chest syndrome and required fewer transfusions than those patients that were not on HU. The authors of this original study were able to calculate a cost savings of over 20 million dollars a year if every eligible patient in the US were taking HU. There is currently no literature that addresses changes in hospital utilization for SCA outside the setting for a clinical study since the implementation of HU.
Methods: Using data collected for the MD Health Services Cost Review Commission, we looked at admission data for the State of MD from FY1995 through FY2003. The ICD9 coding system is an international classification system which groups related disease entities and procedures. The following ICD9 codes were used to identify individuals with SCA: 28261 (sickle cell Hgb SS without crisis), and 28262 (sickle cell, hgb SS with crisis). In order to control for population growth we estimated the total number of individuals with SCA in MD using 1990 and 2000 census data and a prevalence of SCA of 1 in 600 African Americans. Negative binomial and ordinary least squares regression models were used to test the trends in hospitalization rates and length of stay. An inflation factor from the Producer Price Index (PPI) was used to compare 2003 inpatient costs to 1995 inpatient costs. Mann-Whitney tests and t-tests were used to compare the ages, average costs per hospitalization and length of stay among patients admitted to JHH in FY2003.
Results: The rate of adult SCA admissions per estimated African American SCA patient in MD increased from 1.006 in 1995 to 1.29 in 2003 (p < 0.001). The average length of hospital stay decreased from 6.16 to 4.99 over the same time period (p<0.001). The cost of adult inpatient SCA care in 2003 was 60% higher than would be expected by inflation alone. For comparison, the total cost of adult inpatient care in MD in 2003 was 31% higher than expected by inflation alone. Pediatric SCA data for the time period showed that hospitalization rates and length of stay did not change, while 2003 costs were increased by 40% above 1995 costs adjusting for inflation. The total cost of pediatric inpatient care in 2003 for MD was 20% above expected inflation. Ratios of 2003 costs to 1995 costs corrected for inflation and broken down by category can be seen in figure 1 for adults, peds and all MD hospital admissions. No one category clearly explains the cost differences seen over time for any group.
Conclusions: The number of adults admitted with SCA has increased over the last 9 years. Importantly the costs of caring for these patients has increased by almost 60% while the costs of caring for the general population has increased by only 31%. This has occurred while the LOS has significantly decreased. The reasons for the cost increases are unclear and further investigation is warranted.
Cost increases seen from 1995 to 2003
